Roosevelt Institute | Cornell University

CHI St. Gabriel's Prescription Drug Abuse Policy

By Nethan ReddyPublished September 29, 2016

With the passing of the Comprehensive Addiction and Recovery Act (CARA), federal lawmakers are brainstorming new policies to address the opioid epidemic, and are turning to local programs that are using proven methods of handling community-wide substance abuse. Chi St. Gabriel's Prescription Drug Abuse Program is one such hospital worth spotlighting to inform policy.

The opioid epidemic is one that has plagued the nation in recent years, but Congress has finally moved to make some action concerning it and the "war on drugs" at large.

As the opioid epidemic grows in severity, people are demanding new policies that more adequately address the issue than status quo policies, driven by the "war on drugs" and waiting until substance abuse emergencies occur because intervention is usually not present leading up to a potential overdose. The Comprehensive Addiction and Recovery Act (CARA), which was signed into law in
July, is set to provide much needed care for those struggling with substance abuse addiction.

The law particularly targets aid towards those addicted to opioids, as it specifies the need to innovate better ways to combat widespread substance abuse. Based on its demonstrated success, CHI St. Gabriel's Health in Morrison County, Minnesota, could be one of those innovative models for combating substance abuse that could be implemented on a national scale.

Around August 2014, Chi St. Gabriel's Hospital in Morrison County, Minnesota, recognized a significant uptick of patients requesting narcotics to treat their pain. Patients were coming long distances to obtain pain medication from hospital chains that had not served them yet, and healthcare providers in Morrison county fulfilled that role for many.  The Medicaid Managed Care Insurance Plan in the county found that 30% of its patients had eight or more prescriptions of narcotics. The Medicaid Drug monitoring became the number one reason for patients being seen in the emergency room, and the director of the hospital, Kathy Lange, knew some action must be taken.

One measure the hospital took was the usage of multidisciplinary care teams. These teams were made up of physicians, nurses, social workers, and pharmacists that worked together conducting chart reviews and creating holistic treatment plants for patients addicted to narcotics. Another part of the hospital's initiative pertained to education, having providers, municipal leaders, and law enforcement educate the community about prescription drug abuse.

However, perhaps the most essential component involved fostering better communication between doctors and hospitals when discussing patient needs and medical histories. The Minnesota Prescription Monitoring Program (PMP) played a crucial role in efforts to improve communication by allowing doctors to share information, including prescriptions they already have. Enhanced lines of communication identified troubling patterns and patients that are likely in need of substance abuse treatment. This directly led to the significant decrease in "doctor shopping"—patients attempting to obtain narcotics at a number of locations. The comprehensive policy the hospital implemented were extremely effective.

The Morrison County prescription drug abuse project has experienced some notable successes. In 2014, CHI St. Gabriel Health's most common emergency department diagnosis was therapeutic drug monitoring. In November 2015, this diagnosis fell out of the hospital's top 20 most common diagnoses. This program has also decreased the number of pills circulating in Morrison County. In April 2015, a partnering pharmacy filled 43,811 controlled substance prescriptions. Ten months later, this figure fell to 35,018 resulting in a 20% reduction.  The prescription drug abuse policy also proved to be cost-effective. It saved a total of $439,000 of taxpayer dollars by avoiding costly ER visits and a reduced number of pain prescriptions.

Evidently, the hospital's plan to take on prescription drug abuse was proven to be highly effective, and as Washington seeks to find real solutions to the complex problem of substance abuse other than the misguided criminalization policies that only festered the issue, then recognizing the ways hospitals around the nation are targeting substance abuse as a public health issue could be useful in targeting the epidemic.

*much of the information used in this policy blog does not have a web source, as it was taken from a memorandum on a Capitol Hill briefing called "Briefing on Rural Minnesotan Prescription Drug Abuse Project" on July 13, 2016. Contact the author for more information.